Keeping Your Child's Teeth Healthy

When should I schedule my child's first trip to the dentist? Should my 3-year-old
be flossing? How do I know if my child needs braces?

Many parents have a tough time judging how much dental care their kids need. They
know they want to prevent cavities, but they don't always know the best way to do
so. Here are some tips and guidelines.

When Should Kids Start Brushing Their Teeth?

Good dental care begins before a baby's first tooth appears. Just because
you can't see the teeth doesn't mean they aren't there. Teeth actually begin to form
in the second trimester of pregnancy. At birth, your baby has 20 primary teeth, some
of which are fully developed in the jaw.

Here's when and how to care for those little choppers:

Even before your baby starts teething, run a clean, damp washcloth over the gums
to clear away harmful bacteria.

Once your baby gets teeth, brush them with an infant toothbrush. Use water and
a tiny bit of fluoride toothpaste (about the size of a grain of rice). Use fluoride
toothpaste that carries the American Dental Association's (ADA) seal of acceptance.
(If you are using baby toothpaste without the fluoride, keep it to the same amount
because you still want to minimize any toothpaste that is swallowed.)

Once your baby's teeth touch, you can begin flossing in between them.

Around age 2, your child should learn to spit while brushing. Avoid giving your
child water to swish and spit because this might make swallowing toothpaste more likely.

Kids ages 3 and up should use only a pea-sized amount of fluoride toothpaste.

Always supervise kids younger than 8 while brushing, as they are more likely to
swallow toothpaste.

Even babies can develop tooth decay if good feeding habits aren't practiced. Putting
a baby to sleep with a bottle might be convenient, but can harm the baby's teeth.
When the sugars from juice or milk remain on a baby's teeth for hours, they can eat
away at the enamel, creating a condition known as bottle mouth. Pocked,
pitted, or discolored front teeth are signs of bottle mouth. Kids with severe cases
might develop cavities and need all of their front teeth pulled (permanent teeth
will grow in later).

Parents and childcare providers should help young kids set specific times for drinking
each day because sucking on a bottle throughout the day can be equally damaging to
young teeth. Babies as young as 6 months are encouraged to switch
from a bottle to a sippy cup (with a straw or hard spout). By 12 months of age,
they'll have the motor skills and coordination
to use the cup on their own.

When Should Kids See a Dentist?

The ADA recommends that children see a dentist by their first birthday. At
this first visit, the dentist will explain proper brushing and flossing techniques
and do a modified exam while your baby sits on your lap.

These visits can help find problems early and help kids get used to visiting the
dentist so they'll have less fear about going as they get older. Consider taking your
child to a dentist who specializes in treating kids. Pediatric dentists are trained
to handle the wide range of issues associated with kids' dental health. They also
know when to refer you to a different type of specialist, such as an orthodontist
to correct an overbite or an oral surgeon for jaw realignment.

If a child seems to be at risk for cavities or other problems, the dentist may
start applying topical fluoride even before all teeth come in (this also can be done
in the pediatrician's office). Fluoride hardens the tooth enamel, helping to ward
off the most common childhood oral disease — dental cavities (also called dental
caries).

How Can We Prevent Cavities?

Cavities happen when bacteria and food left on the teeth after
eating are not brushed away. Acid collects on a tooth, softening its enamel until
a hole — or cavity — forms.

Here's how to keep cavities away:

Start good oral habits early. Teach kids to brush at least twice
a day with fluoride toothpaste and to floss regularly.

Get enough fluoride.
Regular use of fluoride toughens the enamel, making it harder for acid to penetrate.
Although many towns require tap water to be fluoridated, others don't. If your water
supply is not fluoridated or if your family uses purified water, ask your dentist
for fluoride supplements. Most toothpastes contain fluoride but toothpaste alone will
not fully protect a child's teeth. Be careful, however, since too much fluoride can
cause tooth discoloration. Check with your dentist before supplementing.

Limit or avoid certain foods. Sugary foods, juices, candy
(especially sticky gummy candy, gummy vitamins, or fruit leather or "roll-ups") can
erode enamel and cause cavities. If your kids eat these foods, have them rinse their
mouth or brush their teeth after eating to wash away the sugar. The same goes for
taking sweetened liquid medicines: always have kids rinse or brush afterward.

As your child's permanent teeth grow in, the dentist can help prevent decay by
applying a thin wash of resin (called a sealant) to the back teeth, where most chewing
is done. This protective coating keeps bacteria from settling in the hard-to-reach
crevices of the molars. But make sure that kids know that sealants aren't a replacement
for good brushing and regular flossing.

What Dental Problems Can Happen?

If you are prone to tooth decay or gum disease, your kids might be at higher risk
as well. So sometimes even the best brushing and flossing habits can't prevent a cavity.
Be sure to call your dentist if your child complains of tooth pain, which could be
a sign of a cavity that needs treatment.

New materials mean pediatric dentists have more filling and repair options than
ever. A silver-colored material called amalgam (a special mix of metals) was once
the substance of choice for most fillings in permanent teeth. But now, other
materials like composite resins are becoming popular. Resins bond to the teeth
so the filling won't pop out, and also can be used to rebuild teeth damaged through
injury or conditions like a cleft palate. Because resins
are often tooth-colored, they're considered more attractive.

But in cases of fracture, extensive decay, or malformation of baby teeth, dentists
often opt for stainless steel or ceramic crowns. Crowns maintain the tooth while preventing
the decay from spreading.

In some rare instances, usually when a more complicated dental procedure is to
be done, a dentist will recommend using general anesthesia.
Parents should make sure that the professional who gives the medicine is a trained
anesthesiologist or oral surgeon before agreeing to the procedure. Don't be afraid
ask your dentist questions.

Regular checkups and good dental hygiene can help prevent the need for this kind
of extensive dental work. Also, encourage your kids to use a mouthguard during sports,
which can prevent serious dental injuries.

What Is Orthodontia?

As kids get older, their bite and the straightness of
their teeth can become an issue. Orthodontic treatment begins earlier now than it
used to, and braces have changed too.
The embarrassing old gear — a mouth filled with metal wires and braces —
is in the past. Kids as young as age 7 now wear corrective appliances, and plastic-based
(sometimes clear) materials have replaced metal.

Orthodontists know that manipulation of teeth at a younger
age can be easier and more effective in the long run. Younger children's teeth can
be positioned with fairly minor orthodontic devices, preventing major treatment later
on.

Looking Ahead

As kids grow, plan on routine dental checkups anywhere from once every 3 months
to once a year, depending on your dentist's recommendations. Keeping sugary foods
in check, encouraging regular brushing and flossing, and working with your dentist
will lead good dental health.